老年NIDDM患者尿液N－乙酰－β－D－氨基葡萄糖苷酶变化的临床评价

对９６例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者尿液Ｎ－乙酰－β－Ｄ－氨基葡萄糖苷酶（ＮＡＧ）的变化作了临床研究。结果显示：老年患者（６２例）尿液ＮＡＧ排出量（３２．２０±３．８０Ｕ／ｇ·Ｃｒ）高于健康对照组（３２例，７．０１±０．４２Ｕ／ｇ·Ｃｒ）及非老年患者（３４例，１８．８３±２．５７Ｕ／ｇ·Ｃｒ）（Ｐ均＜０．０１）。其增高程度与蛋白尿、糖尿病病程、视网膜微血管病变关系密切。对老年糖尿病患者尿ＮＡＧ水平的观察可作为识别是否合并早期糖尿病肾病的指标之一。     

Ⅱ型糖尿病合并原发性高血压患者的动态血压与微量白蛋白尿的关系

目的：了解Ⅱ型糖尿病（ＮＩＤＤＭ）合并原发性高血压（ＥＨ）患者的动态血压与微量白蛋白尿（ＭＡＵ）的关系。方法：对２６例伴ＭＡＵ的ＮＩＤＤＭ合并ＥＨ患者与２７例正常白蛋白尿（ＮＡＵ）的ＮＩＤＤＭ合并ＥＨ患者的２４ｈ动态血压、胰岛素、糖化血红蛋白、体重指数、血脂等的比较分析,并对所有患者的尿白蛋白排泄率（ＵＡＥＲ）与有关因素进行多因素回归分析。结果：ＭＡＵ组的夜间平均收缩压（ＮＭＳＰ）较ＮＡＵ组显著增高〔（１４１．２０±６．７７）ｍｍＨｇ对（１３０．５３±６．９２）ｍｍＨｇ,Ｐ＜０．００１〕,而且ＮＭＳＰ与ＵＡＥＲ呈独立的相关性〔标准偏回归系数（β）＝０．４５３,Ｐ＝０．０００６〕。结论：在ＮＩＤＤＭ合并ＥＨ患者中,ＮＭＳＰ升高是ＭＡＵ的独立危险因素,而且可能是ＭＡＵ使心血管病死亡率增加的主要原因之一。     

HLA-DQβ链第57位非门冬氨酸在华南地区1型糖尿病易感性中的作用

目的探讨ＨＬＡＤＱβ链第５７位非门冬氨酸（ＮＡ）或门冬氨酸（Ａ）与华南地区１型糖尿病易感性或抵抗性的关系。方法采用一步法序列特异性ＰＣＲ技术（ｓＰＣＲ）对６９例１型糖尿病病人和４７例健康对照者进行ＨＬＡＤＱＢ１基因分型。结果ＮＡ和Ａ频率在１型糖尿病组中分别为６４．５％和３５．５％，在对照组中分别为４０．４％和５９．６％（ＮＡ的相对危险度（ＲＲ）＝２．６８，Ｐ＜０．０１）；表现型ＮＡ／ＮＡ、ＮＡ／Ａ和Ａ／Ａ频率在１型糖尿病组中分别为４７．８％、３３．３％和１８．８％，在对照组中分别为３１．９％、１７．０％和５１．１％（Ｐ＜０．０１），其中表现型Ａ／Ａ频率在１型糖尿病组的分布明显较对照组降低（ＲＲ＝０．２２，Ｐ＜０．０１）。等位基因ＤＱＢ１０３０２和ＤＱＢ１０２０１在１型糖尿病组中，频率较对照组增高。结论研究提示ＮＡ与华南地区１型糖尿病的易感性呈正相关，Ａ与华南地区１型糖尿病的易感性呈负相关。这种关联在儿童起病的１型糖尿病患者中尤其明显。     

血管紧张素Ⅰ转化酶基因多态和2型糖尿病肾病相关性研究

血管紧张素Ⅰ转化酶（ＡＣＥ）基因多态和２型糖尿病肾病（ＤＮ）的关系。方法用ＰＣＲ技术检测１０２例中国汉族２型糖尿病患者ＡＣＥ基因Ｉ／Ｄ多态基因型。结果ＤＮ组（ｎ＝３６）和无ＤＮ组（ｎ＝４９）相比,Ｄ型等位基因和ＤＤ基因型糖频率升高（分别为５９．７％ｖｓ３８．８％,Ｘ＾２＝７．３０,３３．３％ｖｓ１２．２％,Ｘ＾２＝５．５３）,有显著性差异（Ｐ〈０．０５）,病程≤５年合并ＤＮ组（ｎ＝１１）与病程〉５     

醛糖还原酶基因多态性与糖尿病微血管并发症的相关性研究

目的　探讨醛糖还原酶（ＡＲ）基因多态标记（ＡＣ）ｎ 与中国人２ 型糖尿病微血管并发症之间的关系。方法　用３２Ｐ引物末端标记法,经聚合酶链反应变性聚丙烯酰胺凝胶电泳,检测３６２ 例中国人（２１７ 人为２ 型糖尿病,其中１５６ 人合并肾病或视网膜病变,１４５ 人为非糖尿病对照）ＡＲ 基因的二核苷酸（ＡＣ）ｎ 串联重复序列多态标记,比较各组间的等位基因频率和基因型频率。结果　（１）在非糖尿病对照者和２ 型糖尿病患者中,见到七种ＡＲ 基因的等位基因,其中以（ＡＣ）２４（１３８ｂｐ） 等位基因（Ｚ）最常见。（２）同时合并肾病和视网膜病变的２ 型糖尿病组与无并发症的２ 型糖尿病组相比,Ｚ＋ ６等位基因频率显著减少（Ｆｉｓｈｅｒ 确切, Ｐ＝０ ．０３８）, 含Ｚ＋ ６ 等位基因的基因型频率也显著减少（Ｐ＝０．００４）。（３） 无并发症的２ 型糖尿病组与对照组比较其Ｚ＋ ６ 等位基因频率显著增加（ Ｐ＝ ０．０４４） 。（４）２ 型糖尿病合并肾病伴肾功能不全者与不伴有肾病的２ 型糖尿病者相比,Ｚ－ ２ 等位基因频率显著增加（ Ｐ＝ ０ ．０３９）,同时含Ｚ－ ２ 等位基因的基因型频率也呈增加趋势。结论　ＡＲ 的Ｚ－ ２ 等位基因是促进中国人２ 型糖尿病并发严     

尿转铁蛋白排泄率测定对糖尿病肾病早期诊断的意义

应用免疫速率散射比浊法测定５２例健康人和７６例无临床蛋白尿的糖尿病患者２小时尿微量白蛋白（Ａｌｂ）和微量转铁蛋白（ＴＲＦ）的排泄率（ＡＥＲ和ＴＥＲ）。结果：１．糖尿病组ＡＥＲ和ＴＥＲ均明显高于正常对照组（Ｐ＜０．０１）。２．在糖尿病组中，３２．９％的患者ＡＥＲ升高，４３．４％的患者ＴＥＲ升高，两者有显著性差异（Ｐ＜０．０１）。ＴＥＲ和ＡＥＲ呈明显正相关（ｒ＝０．９３，Ｐ＜０．０１）。３．在ＡＥＲ升高和ＴＥＲ升高糖尿病组中，其血压分别稍高于ＡＥＲ正常糖尿病组和ＴＥＲ正常糖尿病组，差异有显著性意义（Ｐ＜０．０５），而空腹血糖水平无此变化（Ｐ＞０．０５）。与无视网膜病变组相比，有视网膜病变组ＡＥＲ、ＴＥＲ升高的阳性率增加，两者有显著性差异（Ｐ＜０．０５）。提示：ＴＥＲ做为糖尿病肾病早期诊断指标，可能与ＡＥＲ具有相同的意义，甚至较其敏感。     

2型糖尿病患者血清脂蛋白(a)水平变化及其意义

目的　探讨２ 型糖尿病血清Ｌｐ（ａ） 水平与尿白蛋白排泄率的关系。方法　应用单克隆抗体酶联免疫吸附法测定了３１ 例非糖尿病患者和８３ 例２ 型糖尿病患者的血清Ｌｐ（ａ） 水平,并分析它与尿白蛋白排泄率（ＵＡＥＲ） 的相关性。８３ 例２ 型糖尿病患者,根据ＵＡＥＲ 将其分为３ 组：①非糖尿病肾病（ＤＮ）者３２ 例（ＵＡＥＲ＜ ２０ μｇ／ｍｉｎ） ;②微量白蛋白尿者３９ 例（ＵＡＥＲ 介于２０～２００ μｇ／ｍｉｎ之间） ;③大量白蛋白尿者１２ 例（ＵＡＥＲ＞ ２００ μｇ／ｍｉｎ） 。结果　（１） 非糖尿病患者和２ 型糖尿病无ＤＮ 者间血清Ｌｐ（ａ）水平无显著性差异〔（８６ ．４４ ±２ ．１０）ｍｇ／Ｌｖｓ（９３ ．６０ ±１ ．８６）ｍｇ／Ｌ,Ｐ＞ ０ ．０５〕;而在２ 型糖尿病微量白蛋白尿者Ｌｐ（ａ）水平显著升高〔（１４１．１９±２ ．５９）ｍｇ／Ｌ,与非糖尿病患者和２ 型糖尿病无ＤＮ者相比,Ｐ均＜０ ．０５〕;２ 型糖尿病并大量白蛋白尿者Ｌｐ（ａ） 水平有进一步升高〔（２４７ ．５７±１ ．９０）ｍｇ／Ｌ,与非糖尿病患者、２ 型糖尿病无ＤＮ者以及２ 型糖尿病并微量白蛋白尿者相比有显著升高,Ｐ均＜０ ．０５〕。（２）２ 型糖尿病患者中, 血清Ｌｐ（     

老年人非胰岛素依赖型糖尿病与脂蛋白（a）的关系

目的了解老年非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者及其慢性并发症和并存症者血清脂蛋白（ａ）〔Ｌｐ（ａ）〕变化情况。方法测定８９例老年ＮＩＤＤＭ和６１例非老年ＮＩＤＤＭ患者并以６２例老年非糖尿病健康者作对照的血清Ｌｐ（ａ）和其它血脂水平，并分析了老年ＮＩＤＤＭ组并发症及并存症对血清Ｌｐ（ａ）的影响。结果３组血清Ｌｐ（ａ）浓度差异无显著性（Ｐ＞０．０５），Ｌｐ（ａ）与血清总胆固醇、甘油三酯、高密度脂蛋白－胆固醇及其亚型、低密度脂蛋白－胆固醇、载脂蛋白Ａ１和Ｂ水平无明显相关性（ｒ＝－０．０４１～０．１９７，均为Ｐ＞０．１）。老年ＮＩＤＤＭ组合并高血压、糖尿病性视网膜病变和肾病变者的血清Ｌｐ（ａ）浓度明显高于无合并相应疾病者（Ｐ＜０．０５或Ｐ＜０．００１）；血清尿素氮、肌酐、尿微量白蛋白排泄率升高、尿蛋白定性阳性者血清Ｌｐ（ａ）明显高于肾功能正常者（均为Ｐ＜０．００５）；血糖化血红蛋白Ａ１ｃ≥８％者其Ｌｐ（ａ）明显高于＜８％者（Ｐ＜０．００５）。结论老年ＮＩＤＤＭ患者血清Ｌｐ（ａ）浓度与对照组差异无显著性；合并高血压、糖尿病性视网膜病变和肾病变及肾功能异常、糖化血红蛋白Ａ１ｃ≥８％者血清Ｌｐ（ａ）明显升高。     

粘附分子与实验性糖尿病视网膜病变的初步研究

目的　探讨粘附分子在糖尿病视网膜病变（ Ｄ Ｒ） 发病中的作用。方法　应用链脲佐菌素（ Ｓ Ｔ Ｚ） 建立糖尿病大鼠模型,分别于成模后３ 个月和６ 个月时经光镜和透射电镜观察视网膜的形态学改变。应用免疫组化方法及微机图像处理系统,对视网膜组织细胞间粘附分子１（ Ｉ Ｃ Ａ Ｍ１） 及整合素族 Ｃ Ｄ６１ 的分布与含量进行动态观察与分析;应用流式细胞术测定循环血中粒细胞表面β２ 整合素族 Ｃ Ｄ１１ａ 、 Ｃ Ｄ１１ｂ 的表达。结果　病变３ 月组已有 Ｉ Ｃ Ａ Ｍ１ 及 Ｃ Ｄ６１ 的表达明显增加,并随病程延长表达进一步增多,而在正常对照组未见明显表达（ Ｐ＜ ０ ．０１） 。糖尿病大鼠粒细胞表面抗原 Ｃ Ｄ１１ａ 、 Ｃ Ｄ１１ｂ 阳性细胞群体所占的比例较对照组显著升高（ Ｐ＜ ０ ．００１） 。视网膜毛细血管基底膜厚度与 Ｉ Ｃ Ａ Ｍ１ 、 Ｃ Ｄ６１ 表达灰度值呈显著正相关（ ｒ ＝ ０ ．７７２ ,０ ．６９４ , Ｐ＜ ０ ．０５） 。结论　粘附分子与其配基过度表达,加重内皮细胞损伤及微血管栓塞,很可能是导致 Ｄ Ｒ 发生中进展性微血管病变的重要因素之一。     

2型糖尿病患者初诊时血管并发症患病率的调查分析

按ＷＨＯ多国家血管研究方案，对１９９３年患病率调查所筛选出来的２型糖尿病患者的血管病变进行了前瞻性的调查分析。ＤＭ９６６例和正常糖耐量２９９６０例（均经７５ｇＯＧＴＴ诊断）。并发症判定标准：①高血压（ＨＴ）：收缩压（ＳＢＰ）≥２１．３ｋＰａ（１６０ｍｍＨｇ）或舒张压（ＤＢＰ）≥１２ｋＰａ（９０ｍｍＨｇ）；②冠心病（ＣＨＤ）：临床症状及明尼苏达编码的心电图诊断；③微量白蛋白尿（ＭＡＵ）：尿白蛋白排出量（ＵＡＥ）２０～２００μｇ／ｍｉｎ；④脑血管病（ＣＶＤ）：采用问卷和查体调查，有阳性征象者行ＣＴ证实；⑤糖尿病视网膜病变（ＤＲ）为散瞳检查或眼底荧光造影确定。结果显示：初诊２型糖尿病患者ＨＴ、ＣＨＤ、ＣＩ和ＭＡＵ的患病率分别为３７．３７％，９．３２％，５．５３％和２１．０５％均显著地高于对照组的相应患病率（１４．４％，２．４６％，１．１９％和４．３２％）。ＤＲ的患病率为１６．６％，对照组未进行荧光造影。经多元逐步回归分析，ＦＢＳ、ＭＢＰ和ＢＭＩ升高以及血脂紊乱为其血管并发症的独立危险因素。上述并发症的患病率显著高于对照组。控制血糖和血压、保持理想体重、纠正脂质代谢紊乱等，对防止糖尿病血管并发症将起积极作用     

Assessment of Cardiac Autonomic Nervous Activities by Means of ECG R‐R Interval Power Spectral Analysis and Cardiac Depolarization‐Repolarization Process

Background: Cardiac autonomic dysfunction is prevalent in diabetic patients and associated with prolongation of myocardial repolarization period. It was speculated that changes in autonomic nervous system activity, particularly the sympatho‐vagal balance contributes to the prolongation of myocardial repolarization. Methods: Ten patients with ischemic heart disease (IHD), thirty patients with diabetes mellitus, and ten control subjects (CONT) volunteered for this study. The patients with diabetes mellitus were further divided into three subgroups according to the severity of neuropathy: patients without any neuropathy (NO), with peripheral neuropathy (N1) and with autonomic neuropathy (N2). ECG activation time (AT), activation recovery interval (ARI), and recovery time (RT) was measured and ECG R‐R spectral analysis was performed. Result: There were significant decreases (P < 0.01) in RTc in N1, N2, and IHD as compared with CONT and NO. In addition, HI of R‐R interval power spectrum were significantly decreased (P < 0.01) in N1, N2, and IHD than those in CONT and NO. Conclusion: We have successfully developed and adapted a new computer system for simultaneous ECG RT measurements and ECG R‐R power spectral analysis, a putative index of autonomic dysfunction and risk for sudden cardiac death, to study patients with ischemic heart disease and with varying degrees of diabetic autonomic neuropathy. Those with little HI power, which reflects more severe diabetic neuropathy and a high risk of sudden cardiac death, had significantly longer RTc, which is consistent with sympatho‐vagal imbalance toward parasympathetic denervation.     

糖尿病性心自主神经、末梢神经病变与糖尿病微血管并发症的关系

目的 观察糖尿病性心自主神经病变和末梢神经病变的患病率及其与其他糖尿病慢性并发症的关系。方法 利用心自主神经功能检测系统和神经电生理检测仪测定308例糖尿病患者（平均年龄49岁，平均HbA1c9.8%。平均病程14年）的心自主神经功能和肢体的末梢神经传导速度，皮肤痛温觉，振动觉，同时检测24h尿白蛋白排泄率和眼底视网膜照相。结果 糖尿病患者心自主神经病变患病率为47.1%。末梢神经病变患病率为54.2%,两者呈显著正相关。并与病程和糖尿病控制状况呈显著正相关。并发糖尿病性神经病变患者并发其他糖尿病慢性并发症的机率增高。结论 糖尿病性神经病变患病率较高，并与糖尿病其他慢性并发症密切相关。     

高同型半胱氨酸血症与糖尿病周围神经病变的关系

目的了解同型半胱氨酸（Hcy）在2型糖尿病周围神经病变（DPN）患者血浆中的表达水平,干预Hcy表达观察其对DPN的影响。方法200名DPN患者（DPN＋组）和200名无DPN患者（DPN-组）,均检测血浆Hcy水平,将高水平Hcy患者随机分成两亚组。干预亚组给予叶酸、维生素B6,对照亚组不给予干预治疗,3个月后比较各组Hcy水平,并通过临床和电生理方法评估两组神经病变的改变。结果DPN＋组中高Hcy血症患者占40%,其Hcy水平明显高于DPN-组（P〈0.05）。经治疗后高Hcy患者Hcy水平明显下降（P〈0.01）,神经病变症状和神经传导速度与对照组比较也明显改善（P〈0.05）。结论高Hcy为DPN危险因素,有效干预高同型半胱氨酸血症有助于改善神经病变。     

An insertion/deletion polymorphism in the alpha2B adrenoceptor gene is associated with peripheral neuropathy in patients with type 2 diabetes mellitus.

Alpha2B adrenoceptor (alpha2B-AR) mediates a variety of functions in humans. An insertion/deletion (I/D) polymorphism of the alpha2B-AR gene located on chromosome 2 has been described. The aim of the present study was to investigate the potential association between alpha2B gene I/D polymorphism and peripheral neuropathy in Greek patients with type 2 diabetes mellitus. The study included 130 patients (70 men) with diabetic neuropathy (group A) and 60 patients (34 men) without diabetic neuropathy (group B). There was no difference in age, gender and diabetes duration between the groups. Diabetic neuropathy was diagnosed by clinical examination using the Diabetic Neuropathy Index (DNI). Genotyping of I/D polymorphism was performed by PCR. Frequency of the D allele was significantly higher (p=0.001) in group A (26.9%) as compared to group B (11.7%). DNI score differed significantly (p=0.001) between the three genotype groups (I/I, I/D, D/D). It was significantly higher (p=0.04) in patients with I/D (3.7+/-1) than in those with I/I (2.5+/-0.9) and significantly higher (p=0.001) in patients with D/D (5.6+/-1.3) than in those with I/D (3.7+/-1). CONCLUSIONS: Patients with neuropathy exhibit a significantly higher frequency of the D allele in comparison to those without neuropathy. Presence of the D allele is also associated with a higher neuropathic score. These results provide evidence for an association of the D allele with both presence and severity of neuropathy in patients with type 2 diabetes mellitus.     

2型糖尿病下肢神经病变心率变异性频域参数的昼夜节律

采用24 h动态心电图检测58例2型糖尿病伴下肢神经病变组、59例2型糖尿病不伴下肢神经病变组(非下肢神经病变组)和50例对照组的心率变异性,比较其频域参数的水平及昼夜间的变化.结果 显示非下肢神经病变组、下肢神经病变组较对照组频域指标减小,平均心率增加;昼夜间比较在对照组差异有统计学意义,在非下肢神经病变组昼夜节律发生改变,在下肢神经病变组昼夜节律消失.提示糖尿病不伴和伴下肢神经病变均存在自主神经功能受损,后者受损更明显.

Abstract：

Heart rate variability(HRV)analysis and its circadian rhythm(CR)were determined in 58patients with type 2 diabetes mellitus with lower extremity neuropathy(diabetic neuropathy group), 59 patients with type 2 diabetes mellitus without lower extremity neuropathy(diabetes group), and 50 healthy controls according to 24-hour Holter recording. Frequency domain parameters of HRV were significantly decreased in both diabetes groups. Frequency domain parameter of HRV in healthy controls,and daytime/nighttime difference were statistically significant. CR of HRV was changed in diabetes group and disappeared in diabetic neuropathy group. Impaired and seriously impaired autonomic nervous function developed in type 2 diabetes mellitus without and with lower extremity neuropathy respectively.     

2型糖尿病及糖尿病肾病危险因素分析

目的 研究2型糖尿病（DM）及糖尿病肾病（DN）的易患因素，指导临床及早防治。方法 随机选择2型糖尿病病例201例，人群对照110例作病例对照研究。根据尿白蛋白排泄率（UAER）将DM患者分为四组互为对照比较。结果 与人群对照组相比，DM组在饮酒、喜食甜食、过多摄入动物脂肪、糖尿病家族史、女性病人巨大儿生产史、合并冠心病、高血压、脑血管意外、高脂血症、胰岛素敏感性指标方面有显著差异。DM四组间在年龄、病程、继发糖尿病眼病、糖尿病神经病变、合并高血压、冠心病、脑血管意外、胆囊结石、心电图异常、收缩压、舒张压有显著差异。UAER与糖尿病肾病、眼病、冠心病正相关。结论 饮酒、喜食甜食、过多摄入动物脂肪、糖尿病家族史、女性病人巨大儿生产史、合并冠心病、高血压、脑血管意外、高脂血症、胰岛素抵抗等可能是2型糖尿病的危险因素。血糖、血脂、血压的不良控制导致糖尿病肾病的进展，DN与其他血管并发症或合并症有较好的相关性。定期监测尿白蛋白排泄率对于及早发现防治糖尿病肾病和其它血管并发症具有重要意义。     

Increased prevalence of symptoms of gastroesophageal reflux diseases in type 2 diabetics with neuropathy

AIM： To analyze the prevalence of gastroesophageal reflux disease （GERD） related symptoms in patients with diabetes mellitus （DM） and to find out the relationship between diabetic neuropathy and the prevalence of GERD symptoms.
METHODS： In this prospective questionnaire study, 150 consecutive type 2 diabetic patients attending the endocrine clinic were enrolled. A junior physician helped the patients to understand the questions. Patients were asked about the presence of five most frequent symptoms of GERD that included heartburn （at least 1/wk）, regurgitation, chest pain, hoarseness of voice and chronic cough. Patients with past medical history of angina, COPD, asthma, cough due to ACEI or preexisting GERD prior to onset of diabetes and apparent psychiatric disorders were excluded from the survey. We further divided the patients into two groups based on presence or absence of peripheral neuropathy. Out of 150 patients, 46 had neuropathy, whereas 104 patients did not have neuropathy. Data are expressed as mean ± SD, and number of patients in each category and percentage of total patients in that group. Normal distributions between groups were compared with Student t test and the prevalence rates between groups were compared with Chi-square tests for significance.
RESULTS： The average duration of diabetes were 12 ± 9.2 years and the average HbAlc level of this group was 7.7% ± 2.0%. The mean weight and BMI were 198 ± 54 Ibs. and 32 ± 7.2 kg/m^2. Forty percent （61/150） patients reported having at least one of the symptoms of GERD and thirty percent （45/150） reported having heartburn at least once a week. The prevalence of GERD symptoms is higher in patients with neuropathy than patients without neuropathy （58.7% vs 32.7%, P 〈 0.01）. The prevalence of heartburn, chest pain and chronic cough are also higher in patients with neuropathy than in patients without neuropathy （43.5% vs 24%; 10.9% vs 4.8% and 17.8% vs 6.7% respectively, P 〈 0.05）.
CONCLUSION： The prevalence     

Microvascular Complications in Adolescents with Type 1 Diabetes Mellitus

Objective: Screening of complications is an important part of diabetes care. The aim of this study was to investigate diabetic complications and related risk factors in adolescents with type 1 diabetes mellitus (T1DM).Methods: This cross-sectional study was conducted on type 1 diabetics who were over 11 years of age or had a diabetes duration of 2 years and included 155 adolescents with T1DM (67 male, 88 female). The mean age of the patients was 14.4±2.1 years. Mean diabetes duration was 6.3±2.9 years. The patients were screened for diabetic nephropathy, retinopathy and peripheral neuropathy.Results: Mean glycosylated hemoglobin (HbA1c) level of the study group was 8.4%. The frequency of microalbuminuria and peripheral neuropathy were 16.1% and 0.6%, respectively. None of the patients had diabetic retinopathy. Dyslipidemia and hypertension rates were 30.3% and 12.3%, respectively. Risk factors associated with microalbuminuria were hypertension, higher HbA1c levels, longer diabetes duration and dyslipidemia.Conclusion: Early diagnosis and treatment of hypertension and dyslipidemia as well as achieving a better metabolic control are important in prevention or postponement of complications in patients with T1DM. Yearly screening for diabetic nephropathy should be started 2 years after the onset of the diabetes. Conflict of interest:None declared.     

2型糖尿病患者高血压与糖尿病性神经病变的关系

目的 探讨2型糖尿病患者高血压与糖尿病性神经病变的关系。方法 利用心自主神经功能检测系统和神经电生理检测仪对107例（高血压组52例,非高血压组55例）2型糖尿病患者的心自主神经功能和肢体的末梢神经传导速度、皮肤痛温觉、振动沉进行测定,以判断心自主神经病变和末梢神经病变。结果 两组间末梢神经功能和心自主神经功能各指标除心的是距频谱分析的高频值外差异均无显著性（P＜0.05）。Logistic回归分析显示高血压与心自主神经病变显著相关（P＜0.01）,而与末梢神经病变无显著相关。结论 2型糖尿病患者高血压是心自主神经病变发病的危险因素,而与末梢神经病变无明显关系。     

Diabetes mellitus in older African-Americans, Hispanics, and whites in an academic hospital-based geriatrics practice.

BACKGROUND: Diabetes mellitus is a risk factor for target-organ damage/clinical cardiovascular disease in older persons. DESIGN: A retrospective analysis was performed of charts from all older persons (506 men and 1497 women, mean age 80 +/- 8 years) seen during the period from 1 January 1998 to October 1998 at an academic hospital-based geriatrics practice, to investigate the prevalence of diabetes mellitus, and the prevalence, in patients with diabetes, of target-organ damage/clinical cardiovascular disease, hypertension, hypertension or dyslipidaemia, obesity, the drugs used to treat diabetes, and poor glycaemic control. RESULTS: Diabetes mellitus occurred in 127 of 1150 whites (11%), in 93 of 444 African-Americans (21%), in 111 of 381 Hispanics (29%), and in four of 28 Asians (14%) (P < 0.001 comparing Hispanics with whites and comparing African-Americans with whites; P < 0.01 comparing Hispanics with African-Americans). Of 335 patients with diabetes, 146 (44%) had coronary disease, 94 (28%) had stroke or transient cerebral ischaemic attack, 86 (26%) had peripheral arterial disease, 65 (19%) had heart failure, 107 (32%) had nephropathy, 71 (21%) had retinopathy, 47 (14%) had neuropathy, 284 (85%) had target-organ damage/clinical cardiovascular disease, 252 (75%) had hypertension, 300 (90%) had hypertension or dyslipidaemia, and 152 (45%) had obesity. The prevalence of stroke or transient cerebral ischaemic attack was greater in older African-Americans with diabetes mellitus than in older whites with diabetes mellitus (P < 0.02). The prevalence of diabetic nephropathy and of target-organ damage/clinical cardiovascular disease was greater in older African-Americans with diabetes mellitus than in older whites (P < 0.02) and Hispanics (P < 0.05) with diabetes mellitus. Increased concentrations of glycosylated haemoglobin (> 7%) occurred in 28 of 86 African-Americans (33%), in 69 of 104 Hispanics (66%), and in 23 of 118 whites (19%) (P < 0.001 comparing Hispanics with whites and comparing Hispanics with African-Americans; P < 0.05 comparing African-Americans with whites). CONCLUSIONS: The prevalence of diabetes mellitus in 2003 older persons seen in an academic hospital-based geriatrics practice was 17% and was greater in Hispanics than in whites or African-Americans, and greater in African-Americans than in whites. The prevalence of target-organ damage/clinical cardiovascular disease was 85% in 335 older patients with diabetes. The prevalence of stroke or transient cerebral ischaemic attack was greater in older African-Americans with diabetes mellitus than in older whites with the disorder. The prevalence of diabetic nephropathy and of target-organ damage/clinical cardiovascular disease was greater in older African-Americans with diabetes mellitus than in older whites and Hispanics with diabetes mellitus. The prevalence of poor glycaemic control was greater in Hispanics than in whites or African-Americans and greater in African-Americans than in whites.